Retroverted uterus: Everything you need to know about having a tilted uterus
Get the answers to your questions about retroverted uterus straight from an obstetrician-gynecologist.
Many know what a uterus is, but the term retroverted uterus is not a familiar one. What is it anyway?
According to obstetrician-gynecologist Kristine C. Tangco, MD, FPOGS, FPSUOG, a woman’s uterus is retroverted if it is tipped backwards towards the rectum, rather than towards the belly and facing the urinary bladder, which is the regular position.
“The uterus is a pear-shaped organ in the pelvic cavity held in place by several bands of tissues called ligaments. It is usually positioned with its fundus or top part facing the urinary bladder (anteverted). In a woman with a retroverted uterus, the fundus is tipped backwards or posteriorly. Instead of the fundus facing the urinary bladder, the uterus is tipped towards the rectum and the spine,” explains Dr. Tangco.
- Normal anatomic variation
Generally, the uterus moves into a forward tilt (facing the bladder) as the woman matures. But this does not happen to some women; their uteri remain tipped backwards (facing the rectum and spine).
- Myomas or Fibroids
These are small, non cancerous masses or lumps that grow in or on the uterus, making the organ susceptible to tipping backwards.
The endometrium is the lining of the uterus. Endometriosis is the growth of endometrial cells outside of the uterus. These cells can bring about retroversion by causing adhesions of the uterus to other pelvic structures.
An adhesion is a band of scar tissues that joins two separate anatomic surfaces together. Pelvic surgery, endometriosis, and pelvic inflammatory disease are conditions that can cause adhesions to form and pull the uterus into a retroverted position.
- Pregnancy and childbirth
The position the uterus settles into after a woman gives birth depends on a number of factors, including how much the ligaments have stretched during pregnancy and how much weight a woman has gained. Added weight puts pressure on the uterus and can affect its postpartum position.
About twenty percent of women worldwide have uteri that are naturally retroverted.
“Having a retroverted uterus has no bearing on a woman’s reproductive career. It is not associated with problems in conception or a woman’s fertility,” attests Dr. Tangco.
On the whole, it doesn’t affect pregnancy. As the baby grows in the first trimester, the uterus expands in the pelvic cavity, and by 12 to 13 weeks of pregnancy, the uterus grows up and out of the pelvis and into the abdomen to accommodate the growing baby.
In general, a retroverted uterus does not cause problems. If problems do occur, an associated condition that a woman might have like endometriosis is the probable culprit. Two symptoms of this would be pain and discomfort during sexual intercourse – especially when the woman is on top – and pain during menstruation.
These are the treatment options if a retroverted uterus is causing problems:
- Medical or surgical treatment of the underlying condition/s (endometriosis, pelvic inflammatory disease, adhesions and myomas).
If the movement of the uterus is not hindered by the above mentioned conditions, and if the doctor can manually reposition the uterus during pelvic examination, exercises may help.
This is a small silicone or plastic device that can be placed temporarily or permanently inside the vagina. It helps prop the uterus into a forward lean. But because a pessary is a foreign object, it has disadvantages, warns Dr. Tangco. It can trigger pelvic infection and inflammation, make sexual intercourse painful for the woman, and cause discomfort as well for her partner.
- Treatment for incarcerated uterus
Incarcerated uterus is a very rare obstetrical complication wherein the pregnant and growing uterus remains persistently in a retroverted position. As a result, it becomes wedged into the pelvic cavity. This condition can be improved by hospitalization, insertion of a urinary catheter to empty the bladder, and a series of exercises such as pelvic rocking to help free the uterus.
About the expert: Obstetrician-gynecologist Kristine C. Tangco, MD, FPOGS, FPSUOG, practices at the Cardinal Santos Medical Center in San Juan and at In My Womb Ultrasound Centre-SM Megamall in Mandaluyong.
About the author: Regina Posadas
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